> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # DASS-21 — Depression, Anxiety, Stress Scales > Three subscales in one 21-item form — when symptoms overlap and you need to separate depression, anxiety, and stress arousal. The DASS-21 splits negative emotional state into three distinct subscales: Depression, Anxiety, and Stress. That separation is the reason to use it. A client whose PHQ-9 is moderate and whose GAD-7 is also moderate may look like a clean depression-plus-GAD case — but the DASS-21 can show that the bulk of the load is actually non-specific stress arousal, which points your treatment plan somewhere different. Twenty-one items, one week look-back, three subscale scores. Free for clinical use — Lovibond's stated position: "Researchers and clinicians are welcome to use the DASS in their work." ## What it measures Three independent dimensions, seven items each: * **Depression (D)** — dysphoria, hopelessness, devaluation of life, self-deprecation, anhedonia, inertia. * **Anxiety (A)** — autonomic arousal, situational anxiety, subjective experience of anxious affect. * **Stress (S)** — chronic non-specific arousal: difficulty relaxing, nervous energy, irritability, agitation, impatience. The Stress subscale is the differentiator. It captures the overactivated, can't-wind-down state that PHQ-9 and GAD-7 don't reach. ## When to use it * **Mixed presentations.** A client whose symptoms blur across depression and anxiety — the DASS-21 separates them. * **Burnout and adjustment work.** The Stress subscale is where burnout shows up most cleanly. * **Pre/post a specific intervention.** All three subscales are sensitive to change. * **Less often weekly than PHQ-9** — 21 items is long for routine monitoring. Monthly is the common cadence. ## How clients fill it out Each item rated 0-3 over the past week (Did not apply to me at all → Applied to me very much, or most of the time). Five to seven minutes. Reading level grade 7-8. ## Scoring and severity cutoffs Each subscale is the sum of its seven items, **multiplied by 2**, then matched against severity bands. ### Why the × 2 transformation matters The DASS-21 is a short form of the original 42-item DASS. Lovibond published the severity bands using the 42-item norms. To make a 21-item subscale comparable, each subscale total is doubled — that puts a DASS-21 score on the same scale as the 42-item norms the bands were derived from. Skipping the × 2 step puts every client in a falsely low band. Rivet applies it automatically — the multiplier is part of the scoring config, so the score you see on screen and in the session note is already transformed. ### Severity bands (after × 2) | Severity | Depression | Anxiety | Stress | | ---------------- | ---------- | ------- | ------ | | Normal | 0-9 | 0-7 | 0-14 | | Mild | 10-13 | 8-9 | 15-18 | | Moderate | 14-20 | 10-14 | 19-25 | | Severe | 21-27 | 15-19 | 26-33 | | Extremely severe | 28+ | 20+ | 34+ | (Bands per the Lovibond DASS site at psy.unsw\.edu.au/dass.) ## Clinical change Each subscale tracks independently — a meaningful improvement in Anxiety with no movement in Depression is a real and common pattern. A one-band drop on any subscale is typically interpreted as clinically meaningful. ## Risk flagging The DASS-21 doesn't include a suicide item. If your client lands in Severe or Extremely Severe on Depression, pair with a risk-specific instrument (C-SSRS) and pick up risk in conversation. ## DASS-21 vs PHQ-9 and GAD-7 The [PHQ-9](/clinical-templates/screening/phq-9) and [GAD-7](/clinical-templates/screening/gad-7) pair covers depression and generalized anxiety. The DASS-21 covers those two and adds a third thing neither one measures: general stress and arousal — tension, agitation, being easily upset — that belongs to neither diagnosis. When a client is clearly struggling and the depression and anxiety numbers come back unremarkable, that third subscale is usually where the answer is. The trade-off is length and recognition. Twenty-one items against sixteen, a past-week frame rather than two weeks, and a scoring step the PHQ-9 and GAD-7 don't have — each subscale sum is doubled before you read it against the published bands. The PHQ-9/GAD-7 pair is also what a referrer or insurer expects to see. Most practices use the pair as the routine measure and bring in the DASS-21 when the picture needs separating. ## Is it free to use? **Yes.** The authors' stated position is that “researchers and clinicians are welcome to use the DASS in their work”. ## Citation Lovibond, S. H., & Lovibond, P. F. (1995). *Manual for the Depression Anxiety Stress Scales* (2nd ed.). Psychology Foundation of Australia. Lovibond, P. F., & Lovibond, S. H. (1995). "The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories." *Behaviour Research and Therapy,* 33(3): 335-343. Free clinical use. Verbatim canonical wording. ## When not to use it * **You want a single distress number, not three subscales.** Use the K10. * **You want a DSM-aligned depression score.** Use the PHQ-9. * **You want a generalized-anxiety-disorder-aligned score.** Use the GAD-7. * **Children or adolescents.** Use age-appropriate measures (SDQ, RCADS). ## Related articles The single-score Canadian distress screener. Stress-specific when the DASS Stress subscale is your only focus. DSM-aligned depression score for the depression-specific work.